Kakkar Ajay K, Levine Mark, Pinedo H M, Wolff Robert, Wong John
Department of Surgical Oncology and Technology, Imperial College, London, United Kingdom.
Oncologist. 2003;8(4):381-8. doi: 10.1634/theoncologist.8-4-381.
Venous thromboembolism (VTE) is a common complication in cancer patients and a significant cause of morbidity and mortality. However, little information is available on oncologists' perceptions of the risk of VTE and its management. The Fundamental Research in Oncology and Thrombosis (FRONTLINE) study is the first comprehensive global survey of thrombosis and cancer. The study was designed to collect data on the perceived risk and patterns of practice with regard to VTE in cancer patients undergoing surgical and medical management of their malignancy and to provide information on international and regional practice patterns, allowing for the design of research studies to answer the concerns of practicing clinicians.
Literature reviews were performed to provide a current evidence base against which to compare the findings, and a survey was developed under the guidance of an advisory board. A paper-based reply-paid questionnaire was distributed globally between July and November 2001 to clinicians involved in cancer care and was made available on a dedicated website.
A total of 3,891 completed responses were available for analysis. Brain and pancreatic tumors were considered to carry a high risk for VTE, and 80% of respondents considered the use of central venous lines to be associated with a high risk of VTE. Marked differences were seen in the use of thromboprophylaxis for surgical and medical cancer patients, with over 50% of surgeons reporting that they initiated thromboprophylaxis routinely, while most medical oncologists reported using thromboprophylaxis in less than 5% of medical patients. Low molecular weight heparin (LMWH) was the most popular method of thromboprophylaxis employed in both surgical and medical patients and was more favored by European than U.S. clinicians. Some 20% of respondents reported using aspirin for prophylaxis, despite there being no reliable evidence for this agent as effective in prevention in this population. For the treatment of VTE, LMWH was again the most common initial treatment, although, for the long-term, oral anticoagulation therapy was widely adopted. Many patients were treated for VTE on an outpatient basis, and secondary prevention of VTE was typically continued for 3 to 6 months after an episode of deep vein thrombosis or for longer in the case of pulmonary embolism.
The results of the FRONTLINE survey demonstrate a need for guidelines to direct clinical practice in line with evidence-based data concerning cancer and VTE. Oncologists need to be educated regarding the true risks of VTE associated with certain cancers and on strategies for prevention and treatment to reduce the morbidity and mortality associated with VTE in all cancer patients. The study has also helped identify areas for future research.
静脉血栓栓塞症（VTE）是癌症患者常见的并发症，也是发病和死亡的重要原因。然而，关于肿瘤学家对VTE风险及其管理的认知，目前可用信息较少。肿瘤学与血栓形成基础研究（FRONTLINE）是第一项关于血栓形成与癌症的全面全球调查。该研究旨在收集有关接受恶性肿瘤手术和内科治疗的癌症患者VTE的感知风险和实践模式的数据，并提供国际和地区实践模式的信息，以便设计研究来解答临床医生的关切。
进行文献综述以提供一个当前的证据基础，用于比较研究结果，并在一个咨询委员会的指导下开展一项调查。一份纸质的回邮付费问卷于2001年7月至11月在全球范围内分发给参与癌症护理的临床医生，并在一个专门网站上提供。
共有3891份完整回复可供分析。脑肿瘤和胰腺肿瘤被认为VTE风险高，80%的受访者认为使用中心静脉导管与VTE高风险相关。在对手术和内科癌症患者进行血栓预防方面存在显著差异，超过50%的外科医生报告他们常规启动血栓预防，而大多数肿瘤内科医生报告在不到5%的内科患者中使用血栓预防。低分子量肝素（LMWH）是手术和内科患者中最常用的血栓预防方法，欧洲临床医生比美国临床医生更青睐它。约20%的受访者报告使用阿司匹林进行预防，尽管没有可靠证据表明该药物对该人群预防有效。对于VTE的治疗，LMWH再次是最常见的初始治疗方法，不过从长期来看，口服抗凝治疗被广泛采用。许多患者在门诊接受VTE治疗，VTE的二级预防通常在深静脉血栓形成发作后持续3至6个月，对于肺栓塞患者则持续更长时间。
FRONTLINE调查结果表明需要制定指南，以便根据关于癌症和VTE的循证数据指导临床实践。需要对肿瘤学家进行教育，使其了解与某些癌症相关的VTE的真实风险以及预防和治疗策略，以降低所有癌症患者中与VTE相关的发病率和死亡率。该研究还帮助确定了未来的研究领域。
